CAJ | 학술논문

目的：探讨妊娠合并糖尿病母亲分娩的新生儿脐血血清中S100B蛋白、神经元特异性烯醇化酶(neuron-specific enofase， NSE)、髓鞘碱性蛋白（myelin basic protein，MBP）水平分别与新生儿行为神经测定（Neonatal Behavioral Neurological Assessment，NBNA）评分的相关性。方法：2012年9月至2013年3月在上海交通大学附属第一人民医院产科常规产前检查及分娩的176例单胎孕妇及其分娩的新生儿。参照《2011年妊娠合并糖尿病诊治推荐指南》，将这些产妇分为：血糖正常孕妇组（n=59例）、糖尿病合并妊娠组（DM组，n=32例）、妊娠期糖尿病组（GDM组）；同时根据GDM组患者是否应用胰岛素分为无胰岛素治疗组(GDM-A1组， n=44例)和胰岛素治疗组(GDM-A2组，n=41例)。其中DM组、GDM-A1组和GDM-A2组所分娩的新生儿为实验组。同期孕周相似、血糖正常孕妇所分娩的新生儿为对照组。采用双抗体夹心酶联免疫吸附实验（ELISA）法测定新生儿脐血S100B蛋白、MBP水平。采用电化学方式测定新生儿脐血NSE水平。同时生后3天对新生儿进行新生儿行为神经测定(NBNA)。结果：（1）对照组、GDM-A1组、GDM-A2组、DM组新生儿脐血血清S100B蛋白、NSE、MBP水平组间差异显著（F=13.067，F=14.428，F=8.772，P<0.05）。且与对照组比较，GDM-A1组、GDM-A2组、DM组新生儿脐血血清S100B蛋白、NSE水平上升明显，差异有统计学意义（P<0.05）；与对照组比较，GDM-A2组新生儿脐血血清MBP水平升高，差异有统计学意义（P<0.05）。（2）对照组、GDM-A1组、GDM-A2组、DM组NBNA评分水平组间差异显著（F=7.002， P<0.05）。且与对照组比较，GDM-A1组、GDM-A2组、DM组NBNA评分降低明显，差异有统计学意义（P<0.05）。（3）妊娠合并糖尿病母亲所分娩的新生儿脐血血清S100B蛋白、NSE水平分别与NBNA评分呈负相关(r=-0.0159，r=-0.0177，P<0.05)，新生儿脐血血清MBP水平与NBNA评分无相关性（r=-0.0992，P>0.05）。结论：脐血S100B蛋白、NSE、MBP这三种分子作为新生儿中枢神经系统常在的低表达蛋白，其表达水平升高，提示妊娠合并糖尿病母亲分娩的新生儿存在脑损伤。联合检测脐血S100B蛋白、NSE、MBP和NBNA对早期发现新生儿脑损伤有重要意义。目的：探討妊娠閤併糖尿病母親分娩的新生兒臍血血清中S100B蛋白、神經元特異性烯醇化酶(neuron-specific enofase， NSE)、髓鞘堿性蛋白（myelin basic protein，MBP）水平分彆與新生兒行為神經測定（Neonatal Behavioral Neurological Assessment，NBNA）評分的相關性。方法：2012年9月至2013年3月在上海交通大學附屬第一人民醫院產科常規產前檢查及分娩的176例單胎孕婦及其分娩的新生兒。參照《2011年妊娠閤併糖尿病診治推薦指南》，將這些產婦分為：血糖正常孕婦組（n=59例）、糖尿病閤併妊娠組（DM組，n=32例）、妊娠期糖尿病組（GDM組）；同時根據GDM組患者是否應用胰島素分為無胰島素治療組(GDM-A1組， n=44例)和胰島素治療組(GDM-A2組，n=41例)。其中DM組、GDM-A1組和GDM-A2組所分娩的新生兒為實驗組。同期孕週相似、血糖正常孕婦所分娩的新生兒為對照組。採用雙抗體夾心酶聯免疫吸附實驗（ELISA）法測定新生兒臍血S100B蛋白、MBP水平。採用電化學方式測定新生兒臍血NSE水平。同時生後3天對新生兒進行新生兒行為神經測定(NBNA)。結果：（1）對照組、GDM-A1組、GDM-A2組、DM組新生兒臍血血清S100B蛋白、NSE、MBP水平組間差異顯著（F=13.067，F=14.428，F=8.772，P<0.05）。且與對照組比較，GDM-A1組、GDM-A2組、DM組新生兒臍血血清S100B蛋白、NSE水平上升明顯，差異有統計學意義（P<0.05）；與對照組比較，GDM-A2組新生兒臍血血清MBP水平升高，差異有統計學意義（P<0.05）。（2）對照組、GDM-A1組、GDM-A2組、DM組NBNA評分水平組間差異顯著（F=7.002， P<0.05）。且與對照組比較，GDM-A1組、GDM-A2組、DM組NBNA評分降低明顯，差異有統計學意義（P<0.05）。（3）妊娠閤併糖尿病母親所分娩的新生兒臍血血清S100B蛋白、NSE水平分彆與NBNA評分呈負相關(r=-0.0159，r=-0.0177，P<0.05)，新生兒臍血血清MBP水平與NBNA評分無相關性（r=-0.0992，P>0.05）。結論：臍血S100B蛋白、NSE、MBP這三種分子作為新生兒中樞神經繫統常在的低錶達蛋白，其錶達水平升高，提示妊娠閤併糖尿病母親分娩的新生兒存在腦損傷。聯閤檢測臍血S100B蛋白、NSE、MBP和NBNA對早期髮現新生兒腦損傷有重要意義。
목적：탐토임신합병당뇨병모친분면적신생인제혈혈청중S100B단백、신경원특이성희순화매(neuron-specific enofase， NSE)、수초감성단백（myelin basic protein，MBP）수평분별여신생인행위신경측정（Neonatal Behavioral Neurological Assessment，NBNA）평분적상관성。방법：2012년9월지2013년3월재상해교통대학부속제일인민의원산과상규산전검사급분면적176례단태잉부급기분면적신생인。삼조《2011년임신합병당뇨병진치추천지남》，장저사산부분위：혈당정상잉부조（n=59례）、당뇨병합병임신조（DM조，n=32례）、임신기당뇨병조（GDM조）；동시근거GDM조환자시부응용이도소분위무이도소치료조(GDM-A1조， n=44례)화이도소치료조(GDM-A2조，n=41례)。기중DM조、GDM-A1조화GDM-A2조소분면적신생인위실험조。동기잉주상사、혈당정상잉부소분면적신생인위대조조。채용쌍항체협심매련면역흡부실험（ELISA）법측정신생인제혈S100B단백、MBP수평。채용전화학방식측정신생인제혈NSE수평。동시생후3천대신생인진행신생인행위신경측정(NBNA)。결과：（1）대조조、GDM-A1조、GDM-A2조、DM조신생인제혈혈청S100B단백、NSE、MBP수평조간차이현저（F=13.067，F=14.428，F=8.772，P<0.05）。차여대조조비교，GDM-A1조、GDM-A2조、DM조신생인제혈혈청S100B단백、NSE수평상승명현，차이유통계학의의（P<0.05）；여대조조비교，GDM-A2조신생인제혈혈청MBP수평승고，차이유통계학의의（P<0.05）。（2）대조조、GDM-A1조、GDM-A2조、DM조NBNA평분수평조간차이현저（F=7.002， P<0.05）。차여대조조비교，GDM-A1조、GDM-A2조、DM조NBNA평분강저명현，차이유통계학의의（P<0.05）。（3）임신합병당뇨병모친소분면적신생인제혈혈청S100B단백、NSE수평분별여NBNA평분정부상관(r=-0.0159，r=-0.0177，P<0.05)，신생인제혈혈청MBP수평여NBNA평분무상관성（r=-0.0992，P>0.05）。결론：제혈S100B단백、NSE、MBP저삼충분자작위신생인중추신경계통상재적저표체단백，기표체수평승고，제시임신합병당뇨병모친분면적신생인존재뇌손상。연합검측제혈S100B단백、NSE、MBP화NBNA대조기발현신생인뇌손상유중요의의。
To explore the correlation of S100B protein, neuron-speciifc enofase (NSE) and myelin basic protein (MBP) level in Umbilical cord blood serum from mother with pregnancy associated with diabetes and the neonatal behavior neurological assessment (NBNA) score.Methods:Recommended guidelines of diagnosis and treatment of pregnancy with diabetes in 2011 were performed in 176 pregnant women who had antenatal care and delivered in the department of obstetrics and gynecology of ifrst afifliated people’s hospital of Shanghai Jiaotong University from September 2012 to March 2013. These women were divided into four groups: normal glucose level(n=59), DM (n=32), GDM of non-using insulin (GDM-A1,n=44) and GDM of using insulin (GDM-A2, n=41). The experiment group were collected with childbirth by the pregnancy associated with diabetes mother, including DM, GDM-A1, GDM-A2 group. The control group of normal glucose level pregnant women in hospital childbirth without perinatal hypoxia was chosen in the same period. The ELISA method was used for all newborn umbilical cord blood called S100B protein and MBP level detection. NSE was used for the electrochemical determination of neonatal umbilical cord blood levels. NBNA score was determined in all selected objects children such as 3 days after born.Results:(1) The control group, the GDM-A1 group, GDM-A2 group and DM group of umbilical cord blood serum S100B protein, NSE, MBP level were signiifcant differences between groups ( F=13.067, F=13.067, F=8.772,P<0.05). And compared with control group, the GDM-A1 group, GDM-A2 group and DM group of serum S100B protein, NSE levels and the GDM A2 group of MBP levels had rosen signiifcantly, the difference was statistically signiifcant (P<0.05).(2)The control group, the GDM-A1 group, GDM-A2 group and DM group of neonatal NBNA score level were signiifcant differences between groups (F=7.002,P<0.05). Compared with control group, and GDM-A1, GDM-A2 group and DM group NBNA score decreased signiifcantly, the difference was statistically signiifcant (P<0.05). (3) The levels of S100B protein and NSE levels were respectively negative correlation with NBNA score of diabetic mother birth childbirth by the umbilical cord blood serum (r=-0.0159, r=-0.0177,P<0.05). While MBP and NBNA score had no correlation (r=0.0992,P>0.05).Conclusion:Original S100B protein ,NSE and MBP of umbilical cord blood serum were lower expression proteins in neonatal central nervous system. The higher expression level of these three molecules prompt the neonates of pregnancy associated with diabetes had brain injury. Jointing detection of S100B protein, NSE, MBP and Neonatal Behavioral Neurological Assessment (NBNA) is of great signiifcance to detect neonatal brain injury situation in the early.